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Hardwired for Connection, Hardwired for Connection, Healing, Resiliency & Hope: Healing, Resiliency & Hope:

A Trauma Treatment A Trauma Treatment FrameworkFramework

Hardwired for Connection, Hardwired for Connection, Healing, Resiliency & Hope: Healing, Resiliency & Hope:

A Trauma Treatment A Trauma Treatment FrameworkFramework

Presented by: Mary U. Vicario, LPCC-SPresented by: Mary U. Vicario, LPCC-SSt. Aloysius OrphanageSt. Aloysius Orphanage

Finding Hope Consulting, LLCFinding Hope Consulting, LLC

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The Impact of Trauma on Brain The Impact of Trauma on Brain Development, Attachment & Development, Attachment & Developmental MilestonesDevelopmental Milestones

The Impact of Trauma on Brain The Impact of Trauma on Brain Development, Attachment & Development, Attachment & Developmental MilestonesDevelopmental Milestones

All behavior is purposefulAll behavior is purposefulSigmund FreudSigmund Freud

Strategies for disconnection are an intense Strategies for disconnection are an intense yearning for connection in an atmosphere yearning for connection in an atmosphere of fearof fearMaureen WalkerMaureen Walker

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The Importance of Relationships

Human development is dependent on relational connection for:

Access to resources

Life –beliefs are developed through early relationships

Developmental milestones

Brain development are embedded in relational experiences

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The Significance of Relationships to Human Development

Emotional Development begins chemically in the brain at six months gestation (Schupp, 2004)

The ability to trust, and the brain chemistry connected with it, begin at one month of age.

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Human Brain Development and Relationships

Humans are the only mammals for whom: The whites of the eyes are clearly visible

50% of brain development occurs after birth. (Experience-Dependent Maturation of Neuronal Systems) (Putnam, 2004)

Synaptogenesis: The birth of the connectors (synapses) that are needed for brain development increases dramatically after birth and are dependent upon environment-stimulated activity

Relational Revolution Amy Banks, MD & Mary Vicario, LPCC-S 7

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Brain Growth & Interaction

Why the loss of connections? Repeated use of specific connections strengthens those

connections

Connections that are not used atrophy; they are pruned away

The brain “grows itself” from and for whatever environment it experiences (Rintoul, 1999)

“What fires together wires together and what is wired together fires together” (Putnam, 2004)

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Experiences which strengthen connections are: (Rintoul, 1999)

1. Frequent, regular, and predictable

2. Occur in the context of a safe, warm, supportive relationship

3. Are associated with positive emotions

(fun, humor, excitement, comfort)

4. Involve several senses

5. Are responsive to a child’s needs, interests, or initiative.

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Growth of the Human Brain from birth to 20 years

7 years

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Human Brain Development & Relationships (Schupp, 2004)

The Cortexes are in charge of planning, organizing and executing action while regulating emotions. It performs the functions of Freud's concept of the Superego

The Limbic System houses our emotions and is loosely similar to Freud's concept of the Ego.

The Brain Stem is our “primitive brain.” It controls the autonomic responses of our parasympathetic nervous system and resembles Freud's concept of the Id.

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Meet The CortexesAKA: The King of it All

As the Executive Control Center, the Cortexes: Read non-verbal cues like facial expression, tone of voice, body

language & posture. It’s our social navigator

Control Self Regulation = the ability to regulate emotional arousal to accomplish a task or tolerate unpleasant emotional stimuli (mood stability, frustration tolerance, impulse control)

Control Working Memory, Organization, Planning, Problem Solving, Sequencing

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Cortex Development (Forbes & Post, 2006)

It is developed by connecting the facial expression of the caregiver with what the infant is feeling at the time which because of Mirror Neurons will mirror the caregivers feelings.

Pleasurable sensations develop on one type of nerve fibers and painful emotions develop another type.

(Social Pain Overlap Theory or SPOT Theory)

It is not fully developed until 25 years of age. It is the reason adolescences does not end until age 25

It also can be “influenced” throughout the lifespan(Neuroplasticity)

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Welcome To The Limbic System (Schupp, 2004)

The Amygdala: Houses emotional memory Identifies threat Sets into motion fight or flight

response Decides between the need for

aggression (fight) from fear (flight)

Starts developing at 6 months gestation & continues until 18 months of age.

The Hippocampus: Tracks memory & time Controls consciousness Maintains identity Maintains Circadian

Rhythms to regulate sleep, appetite, digestion, blood pressure

Self Sooths & regulates emotions

Calms the Amygdala by accessing short term memory (in the cortex)

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Welcome to the Brainstem

The brainstem controls bodily functions: ArousalBladderBowlDigestionPerspirationBreathingStartle responses(Things you should not need to think about)

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Brain Development (Rintoul, 1999)

The Cortexes should be the largest part of the brain

The Limbic system the next in size

The Brain stem should be the smallest

Their influence on functioning should be in a ratio that resembles an upside down pyramid. (Perry, 1993)

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Brain Chemistry & Trauma

When the amygdala discerns there is a life threatening event, it signals the hypothalamus which releases

epinephrine, norepinephrine &cortisol to prepare the body to fight or flee

These chemicals are so strong that repeated exposure to them damages the brain.

(Schupp, 2004)

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Brain Chemistry & Trauma

Over time with repeated release of fight or flight chemicals (Schupp, 2004) The cortexes ability to plan, organ and execute action while

regulating emotions is damaged.

The amygdala is damaged & no longer accurately recognizes danger

The hippocampus no longer effectively tracks memory, controls consciousness, identity or circadian rhythms

The brainstem misfires causing enuresis, encopresis, digestive issues, impulsive aggression from an over active startle response

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What Do You See?

When the cortexes no longer effectively:

1. plan

2. organize

3. execute action

4. regulate emotions

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What Do You See?

When the amygdala is no longer accurately

1. recognizes danger

2. responds to danger

3. Self soothes

When the hippocampus no longer effectively

1. tracks memory1. controls

consciousness2. maintains identity3. Regulates sleep &

appetite

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What Do You See?

When the Brainstem misfires autonomic responses (things you do not think about) like:

ArousalBladderBowlDigestionPerspirationBreathingStartle responses

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Clients with PTSD will need help with:

Transitions AKA Shifting cognitive set = The ability to shift from one mind-set to another.

Requires the coordination of the Amygdala and the Cortex

Since trauma causes a transition from safety to danger all transitions become associated with danger

Problem Solving = the ability to organize a coherent plan

The amygdala can interfere with this when it sets off the flight or fight response

The flight or fight chemicals released by the amygdala (corticosteroids) damage the cortex which is needed to plan for transitions & problem solve.

Interventions Transitions:5 – 10 minute warning

using a timer that shows the time passing with color not sound

Visual Schedules

Replace “No & Stop” with “Yes you can (when) & “Pause”“Hold that thought”

Problem Solving:“Bored” box

Homework/Chore/ Play Cards the child can organize in any order they want.

Red, (Orange) Yellow, Green cards to indicate need for assistance

Red & Green snack cards

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Violence in Children’s LivesBy The Percent of Children Exposed in the United States per Year (US Dept. of Health and Human Services, 1997 & 2010)

1997 Exposure to domestic

violence – 5 to 16% Violent crime

victimization – 5.6% Physical Abuse – 1.2% Sexual Abuse – 0.12% Victim of bullying at

school – 7.9% Teen suicide attempt –

8.8% Fighting with peers –

33.2%

2010

Physical Abuse - 0.16% Sexual Abuse - .08 %

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Violence in Children’s Lives

According to Schupp (2004) 40 million women in the United States reported sexual abuse prior to the age of 18 which is equal to one out of three girls which = 33%

The statistic for boys has reached one out of five which = 20%

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Additional Additional Traumatic Factors Factors((Adapted from: Pynoos, Steinberg, Goenjian, 1996)

Exposure to direct life threat Injury to self – extent of physical pain Witnessing of mutilating injury/grotesque death (especially to

family or friends) Hearing unanswered screams or cries of distress Being trapped or helpless Unexpectedness or duration of the experience Number and nature of threats during episode Degree of violation of physical integrity of child Degree of brutality and malevolence

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Resulting Belief Systems from Trauma

Attachment Abuse destroys trust Instills a feeling of

hopelessness Jeckle and Hyde

themes Connection is

dangerous. We are all in this

alone.

Why children hold themselves responsible

Overwhelming feelings, especially shame, influence development

Cannot face reality of vulnerability to malevolent caregivers

Limitations of Pre-operational thought

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Trauma Induced & Co-occurring Trauma Induced & Co-occurring DisordersDisordersTrauma Induced & Co-occurring Trauma Induced & Co-occurring DisordersDisorders

Everything an abused child does after the abuse is Everything an abused child does after the abuse is designed to give them a sense of safetydesigned to give them a sense of safety Eliana GilEliana Gil

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PTSD vs. Complex PTSD(Herman, 1992)

PTSD = Perceived life

threatening situation with intense fear response

Intrusive, avoidant, and hyper-arousal symptoms present

Complex PTSD = A history of prolonged or

repeated totalitarian control with resulting

Alterations in Affect regulation Consciousness Self perception Perceptions of the

perpetrator Relations with others Systems of meaning

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The Cycle of Abuse

Bonding with the Aggressor AKA The Stockholm Syndrome (Rawlings & Carter, 1977)

The Impact of Defenses

(Denial, Dissociation, Minimizing, Manipulation)

Partnering with or becoming an abuser

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Child Abuse & School Problems(Dawud-Noursi, Lamb & Sternberg, 1998)

Greater than 50% of abused children have significant school problems (including conduct problems)

Greater than 25% of abused children require special education programs

Several studies suggest CAN decreases IQ

CAN victims 2 X's more likely to be unemployed as adults

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Trauma-Related PsychopathologyTrauma-Related Psychopathology (Rossman et al, 2000) (Rossman et al, 2000)Trauma-Related PsychopathologyTrauma-Related Psychopathology (Rossman et al, 2000) (Rossman et al, 2000)

Affect dysregulation (depression, mood swings, panic attacks, affect liability)

Use and abuse of substances to regulate mood, sense of self, and behavior

A History of Child Abuse or Neglect is the single best predictor of alcohol or other substance abuse in women

Attentional problems (ADHD Symptoms, impulsivity, hypervigilence)

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The Effects of Fear on Behavior

What the search for safety can look like?

How to use it to promote healing?

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Biologically Based Fear Responses (Forbes & Post, 2007)

1. Manipulating

2. Lying

3. Stealing

4. Hording

5. Aggression

6. Defiance/”Button Pushing”

7. Poor Eye Contact

8. Food issues1. Gorging2. Starving 3. Purging

9. Sleep issues10. Enuresis11. Encopresis12. Self harm

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The Top 5 Things to Remember When Addressing Biologically Based Fear Responses

5. Irritation Equals Fear (Forbes & Post, 2007)

6. All behavior is purposeful (Sigmund Freud)

7. Everything an abused child does after the abuse is designed to give them a sense of safety (Gil, 1991)

8. Connect Limits with safety (Use the Phrase that Pays)

1. The one whose amygdala is calm wins! (Forbes & Post, 2007)

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Manipulation(The Consolation Prize of the Disenfranchised)

Is nothing more than a survival skill learned by those who do not have direct access to the resources they need to survive.

To address manipulation, teach clients to: directly seek what they need when it is safe to do so and teach the significant others in their lives to respond

directly.

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The Safety Script:

“ This is a safe place, and I won’t let anyone _________ you,

so I can’t let you ____________ because this is a safe place.”

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Lying is Learned When

Reality is not allowed to be real

The truth is what you need it to be to get the job done

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Interventions for Lying

Identify their goal – their perceived need for the lie.

1. To Avoid Punishment?

2. To access a perceived need?

3. To solve a problem

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Kitchen Set & Toy Food

Food = Love (AKA Nurturance) Neglect will be acted out through

stealing and /or hording of food Sexual Abuse will be acted out on food They will use food to have a sense of

power Cooking, in play or at home, with a

parent is very healing

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Interventions for Food Issues

1. Discuss favorite foods2. Plan menus 3. Have caregiver or positive person do steps 1 & 2 and go

shopping for the food with client4. Make placemats5. Identify what they would like to talk about over dinner6. Prepare & enjoy a meal together 7. Plan ways to have weekly if not daily meals with positive

people (Resilience factors 1 & 2)8. Plan birthday parties or other celebrations

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Interventions for Sleep Issues & Nocturnal Enuresis

Before Bed:

1. Identify daily successes

2. Rewrite unpleasant parts of the day

3. Identify one challenge from the day

4. Make plans for the challenge

5. Write dreams

6. Remind child they can rewrite dreams while having them

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Interventions for Oppositional-Defiance

1. Give a 5 minute warning for transitions

2. Connect the request/limit with safety

3. Use descriptive vs. evaluative directions

4. Give space (physical & emotional) for compliance

5. Pay it forward - Tell them what you know they are going to do (that is positive)

6. Use a Success Calendar to record daily something they did to accomplish something in a positive way, made the world a better place, helped someone, etc.

7. Use Descriptive instead of Evaluative praise

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To tone down your buttons ask yourself:

1. Identify your implicit memories

2. Who did this to me when I was the client’s age or lately?

3. What do I expect and how did that come to be my expectation?

(It’s most helpful to do this in advance of the stressor by making it a regular part of your day)

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The Three R’s of Trauma The Three R’s of Trauma TreatmentTreatmentThe Three R’s of Trauma The Three R’s of Trauma TreatmentTreatment

The one whose amygdala is calm wins! The one whose amygdala is calm wins!

Heather ForbesHeather Forbes

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The Three R’S of Trauma Recovery

Re-experience: When the client is able to 1. processes the trauma in a realistic way

experiencing whatever levels of pain, anger, loss, or other emotions are elicited by a CLEAR MEMORY (perceives the event accurately and in detail) of the event

2. Does not feel irrationally responsible for having caused the event.

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Emphasize for clients the healing power of their words

“What you share, you can bear.” (Siegel, 2004)

“The more times you tell the story, the more power you have over it and the less power it has over you.” (Vicario)

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Release: The client is able to:

1. Understand that the experience occurred in the past and does not see or react to the experience as a clear and recurring danger in the present. (This is the cognitive part of self-regulation)

2. No longer feels devastated by the memory of the event (This is the emotional part of self-regulation)

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Reorganize: The client is able to:

1. Live their life without feeling compelled to relive or repeat the traumatic event either consciously or unconsciously.

2. Define their life without the trauma being the central organizing piece of who they are and how they live their life; consciously, unconsciously, and chemically.

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Posttraumatic Growth(PTG)

PTG refers to a growth process by which survivors are profoundly affected by the traumatic experience in a way that transforms.

PTG refers to positive changes that go beyond effective coping and adjustment in the face of adversity; movement beyond pre-trauma levels of adaptation.

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The Top Five Resilience The Top Five Resilience FactorsFactorsThe Top Five Resilience The Top Five Resilience FactorsFactors

PTSD is a disorder of hopePTSD is a disorder of hopeBessel van der KolkBessel van der Kolk

What a better way to experience hope What a better way to experience hope than to help othersthan to help othersJudith JordanJudith Jordan

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The Top 5 Resilience Factors

5. Autonomy (Agency): When do you feel in control?

How do you define power and control?

How do you make things happen?

How do you help others, make the world a better place, contribute to the interdependent web of life?

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The Top 5 Resilience Factors

4. Self EsteemA. Sense of Self – Personal Preferences likes &dislikes

B. Sense of Self – Worth When do I feel loved and valued? How do I show others they’re loved and valued? How do I give and receive The Five Good Things?

C. Sense of Self-efficacy – How do I affect change in a positive way? How do I make things happen for the greater good?

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The 5 Components of Mutually Enhancing Relationships

Jean Baker Miller (1976) calls these the “Five Good Things” that result from “growth fostering mutually enhancing relationships.”

1. Zest2. Clarity3. Increased sense of worth4. Creativity/Productivity5. Desire for more connection

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The Top 5 Resilience Factors

3. External Support SystemsFriendsPetsExtended FamilyNeighborsPeople at Church

Even Positive Fantasy

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What was Michael Jackson’s

First solo #1 hit song?

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The Top 5 Resilience Factors

2. Affiliation (with a cohesive supportive group that works together toward a positive goal)

System of Meaning (Rochelle Dalla, 2006) Meaningful Work Church Group SPARK (Lyn Mikel Brown’s work) Games for Change Volunteer Work Scouts Sports 4 H

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The Top 5 Resilience Factors

Positive Experiences with positive adults, especially people in positions of authority

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Top Five Resilience Factors

The Top 5 Resilience Factors5. Autonomy (What do I have control over and how to make things happen?)4. Self Esteem

Sense of Self – Personal Preferences (likes & dislikes)Sense of Self Worth – How do I give & receive love and value?

The Five good things in mutually enhancing relationships 1. Zest2. Clarity3. Increased sense of worth4. Creativity/Productivity5. Desire for more connection

Sense of Self-efficacy – How do I affect change – what do I have power and control over – How do I make things happen?3. External Support Systems (Can be a person, pet, fantasy)2. Affiliation (with a cohesive supportive group)1. YOU! Positive Experiences with adults, especially people in positions of authority

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The World is not dangerous because of those who do The World is not dangerous because of those who do harm but because of those who look at it without doing harm but because of those who look at it without doing anything.anything.

 Albert Einstein Albert Einstein

The World is not dangerous because of those who do The World is not dangerous because of those who do harm but because of those who look at it without doing harm but because of those who look at it without doing anything.anything.

 Albert Einstein Albert Einstein

To embrace the power of relationship will change society as well as psychology ~ Jean Baker Miller

References

Boat, B.W. (2007). “A Toxic Triad: Animal Cruelty, Child Abuse and Domestic Violence,” Child Forensic Interviewer Training, The Childhood Trust, Cincinnati, OH) April 2007.

Child Maltreatment 1997: Reports from the States to the National Child Abuse and Neglect Data System. U.S. Department of Health and Human Services, Administration on Children, Youth and Families, 1997.

Dalla, R. (2006). You cannot hustle all your life: an exploratory investigation of the exit process among street-level prostituted women. Psychology of Women Quarterly. vol. 30 no. 3. pp. 276-290.

Dawud-Noursi,S., Lamb, M.E., Sternberg, K.J. (1998). The relations among domestic violence, peer relationships, and academic performance. IN M. Lewis and C. Feiring (eds.) Family, Risk and Competence. Mahwah, NJ: Lawrence Erlbaum Associates, Inc

De Bellis, M., Kenshavah, M., Clark, D., Casey, B.J., Giedd, J.N., Boring, A.M., Frustaci, K., & Ryan , N,D, (1999). Developmental traumatology, part II: Brain development. Biological Psychiatry, 45, 1259-1284.

References

Forbes, H.T. & Post, B.B. (2006). Beyond Consequences, Logic and Control. Orlando, Fl: Beyond Consequence Institute, LLC.

Herman MD, J. L. (1992). Trauma and Recovery, New York: Harper Collins Publishers, Inc.

Hudgins, K.M. (2002). Experimental Treatment for PTSD: The Therapeutic Spiral Model. New York: Springer Publishing Company, Inc.

Gil, E. (1991).The Healing Power of Play. New York: The Guilford Press.

Greene, R.W. & Ablon, J.S. (2005). Treating Explosive Kids. New York: The Guildford Press

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References

Miller, J.B. (1976).Toward a New Psychology of Women. Boston, MA: Beacon Press

Mounstakas, C.E. (1959). Psychotherapy with Children The Living Relationship. New York: Harper and Row, Publishers, Inc.

McCarty, M. (2006). Little Big Minds, New York: Penguin Group

Putnam, F. W. (2004). The Impact of Trauma on Children’s Brain Development.

Putnam, FW. (2004). Experience Dependent Maturation of Neuronal Systems.

Pynoos, R.S., Steinberg, A.M., & Goenjian, A. (1996). Traumatic stress in childhood and adolescence. In Bessel A. van der Kolk, Alexander C., McFarlane, & Lars Weisaeth (Eds.), Traumatic Stress, pp. 331-358. New York: The Guilford Press

References

Rintoul, B. (2005). Bridging the Social Synapse.

Rawlings, E. I. & Carter, D.K. (1977). Psychotherapy For Women. Springfield, Illinois: Charles C. Thomas Publisher.

Rossman, B.B.R., Hughes, H.M., & Rosenburg, M.S. (2000). Children and Interparental Violence: The Impact of Exposure. Philadelphia, PA: Brunner/Mazel

Schupp, L. J. (2004). Assessing and Treating Trauma and PTSD, Eau Claire, Wisconsin: PESI, LLC

Seigel, D & Hartzell, M. (2004). Parenting From the Inside Out. New York: Penguin Group, Inc.

Wilens,T.E. (2001). Straight Talk About Psychiatric Medication for Kids. New York: Guilford Press.